Danielle Barron speaks to Professor Michael O’Dwyer in advance of this year’s MMI Patient and Family Awareness Day
The annual Multiple Myeloma Ireland Patient and Family Awareness day is an opportunity to benefit from the expertise and experience of health professionals working in the field, as well as hearing from peers about their own multiple myeloma journey.
Ahead of this year’s meeting, which will take place in the Glenroyal Hotel in Maynooth on November 9th, consultant haematologist at Galway University Hospitals Professor Michael O’Dwyer previewed his presentation, which will centre on new developments in multiple myeloma treatment.
When dealing with a disease like multiple myeloma that is essentially incurable, looking at the long game as opposed to the short-term is important. Patients are increasingly eager to learn about treatments that are in development, and will become available in the short-, medium, or even long-term, explains the professor.
“I think it’s part of what they want to know. Every patient I imagine wants to be optimistic about the future and regardless of what treatment they are currently on or how they are doing, even if they are doing very well, some people will always have an eye to the future in case their current treatment stops working or if they relapse.”
While the disease is officially incurable, modern treatment has meant that, for some patients, long periods of remission are possible, he adds.
“I am really talking about younger patients here, but for a small minority of patients, early intensive treatment where they receive a stem cell transplant, may mean a long period of disease-free remission where they are effectively cured. For the vast majority of patients there is an inevitability about their disease relapsing at some point in the future.”
The last decade or so has seen a number of new drugs added to haematologists’ armamentarium when it comes to treating multiple myeloma. “These have had very real impact on the survival of patients in the relapse setting.” While for many years, chemotherapy was the only real choice of therapy, the arrival of thalidomide and the new class of immunomodulatory drugs changed the face of treatment in multiple myeloma, he notes. “This class of drugs have proven very useful in the relapse setting and are now frequently used in combination with traditional therapy.”
The proteasome inhibitors have also had a major impact, but Professor O’Dwyer notes that the second generation drugs in this class are not readily available in Ireland due to funding issues. Similarly, there are issues regarding access to the monoclonal antibodies such as daratumumab.
Clinical trials offer an opportunity for patients to gain early access to these ground-breaking drugs, however, and the professor says he will be encouraging attendees at the awareness day to speak to their haematology team about possible participation.
“As clinicians we always advocate as best we can for our patients but it is becoming increasingly challenging to get access to the drugs that we would like to use in a timely manner, and while we will continue to advocate in this way, right now the most viable and important way of accessing these therapies is via clinical trials.” The establishment of Blood Cancer Network Ireland and the ongoing work of Cancer Trials Ireland has opened up many more trials to Irish patients but Professor O’Dwyer says more needs to be done so that this avenue of drug access is maximised.
“In the frontline setting we are starting to develop a good platform of trials and there are a number of trials in the early developmental stages for patients with relapsed myeloma Irish centres are hoping to partake in. I am very keen to promote this, and there needs to be more support for clinical trials within Ireland in general – active participation and care of patients on clinical trials does take a lot of time and clinicians needs to be freed up to devote that time to clinical research. Unfortunately that isn’t the case in most instances, we are expected to simply do it on top of our workload.”
He adds that while patients in the past felt like “guinea pigs” on clinical trials, nowadays it well-recognised that it is simply another method of delivering care, one that could lead to much better outcomes than the traditional route.
“Patients need to realise, and they are realising, that regardless of the treatment that they end up getting – even if they simply get the standard treatment and not the investigational one – there is overwhelming international evidence that patients who participate in trials tend to do better than their peers who don’t. The general quality of care that is delivered is higher because patients tend to be watched a lot more closely and monitored for side effects, there are more dedicated staff to look after them and they are seen as a priority Rather than being guinea pigs, in the best case scenario a trial can provide a patient with access to a very active treatment that they otherwise wouldn’t be able to get, but even if they just get the standard treatment in a randomised trial, they will get excellent care.”
Professor O’Dwyer is also keen to look further into the future, in terms of developments further down the pipeline. One exciting example is that of CART cells, where the immune cells can be genetically engineered to better recognise myeloma cells and deliver targeted therapy; clinical trials are showing very encouraging results, says the professor. Bi-specific antibodies, which target two different proteins simultaneously on both the tumour cell and the immune cell, are also generating excitement in the myeloma community.
“It’s like the antibody forms a bridge from the immune cell to the tumour cell, activating the immune cell and then allowing it to kill the tumour cell right next to it. This takes advantage of the immune cells already in the patient, it doesn’t require removal of the cells to genetically engineer them like with CAR-T cells,” he explains.
These different approaches will provide many more options for multiple myeloma patients into the future. The real challenge, however, will come when the immunomodulatory drugs and proteasome inhibitors no longer work in a patient. “When their disease is no longer responding to these drugs that’s where it becomes difficult, and that’s why we need access to these new therapies.”
Managing patient expectations is thus a major part of a haematologist’s job. As patients become experts in their own condition and fully aware of advances in the field of myeloma, explaining that certain drugs are not available in Ireland is difficult, admits Professor O’Dwyer.
“Based on the competing needs in the healthcare system and given that a lot of these treatments are very expensive, getting widespread access to them in the future is going to be a challenge – that’s not just in this country but in most countries. Even paying for the drugs we currently have access to is becoming a challenge.”
Register online for the MMI Patient and Family Awareness Day 2017 at: http://www.multiplemyelomaireland.org/registration-for-mmi-2017